Paper I
2022 February (2019 Scheme) · 100 marks · 180 min

Question

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  • (a) Four drugs used to treat Chronic glaucoma with rationale for use of each drug. ( 4 mark(s)
  • (b) Describe the Management of Status epilepticus 4 mark(s)
Q78 marksShort Essays

Answer

a) Four drugs for chronic (open-angle) glaucoma, with rationale

  • Latanoprost (prostaglandin analogue) — increases uveoscleral outflow; first-line, once-daily dosing, strong IOP-lowering effect.
  • Timolol (non-selective beta-blocker) — reduces aqueous humour production at the ciliary epithelium; minimal systemic absorption at ocular doses.
  • Brimonidine (alpha-2 agonist) — reduces aqueous production and increases uveoscleral outflow.
  • Acetazolamide/Dorzolamide (carbonic anhydrase inhibitor) — reduces aqueous humour production by inhibiting bicarbonate-dependent fluid formation in the ciliary body; used topically (dorzolamide) or systemically for add-on control.

b) Management of status epilepticus

  • Immediate: airway, breathing, circulation; oxygen; IV access; check blood glucose (correct hypoglycemia if present, since it’s a reversible seizure cause).
  • First-line: IV Lorazepam or Diazepam — rapid termination via GABA-A receptor potentiation.
  • If seizures continue: IV Phenytoin/Fosphenytoin (loading dose) — sustained seizure control via Na⁺ channel blockade, does not cause the sedation/respiratory depression benzodiazepines do.
  • Refractory status (continues despite the above): IV Valproate or Levetiracetam; if still refractory, general anesthesia (Midazolam, Propofol, or Thiopental infusion) with continuous EEG monitoring and ICU care.

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